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HomeMy WebLinkAboutAFTER THE FACT AS-BUILT FOR THE MAIN HOUSE - SWG As-Built - 9/9/2024 Affer fhle- facf Quit-v fbr from fruse � Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH APPLICANT/ PERMIT INFORMATION zoa4-000a9 Permit Number 4x qq Parcel# Applicant Name VJ grct,TnlloM Subdivision (Name/Div/Block/Lot) Applicant Address III E- Trrjaer" c+. 2 ,21 ,zW w V Nrt S City, State, Zip SIt14nri wA 9 6sR/� Installer Name Site Address qqf4 E &hf Designer Name �t& S INSTALLATION CHECKLIST ❑ Full System Installation ❑Tank(s)Only ❑ Grainfield Only ❑Repair ®Other IZ r ra System Type 6MV,44 Pretreatment Type ot-'[y' npt >5 ft.from foundation?-- - -- - - - ------- -- - - - - - - - - - -- ❑ NIA ®YES NO >50ft.from wells? - - - --- - - - ------- - - - - - - -- - -- - ❑ ® ❑ Z >50ft.from surface wateR - - - - - -- -- -- - - - -- - - - - - - -- ❑ ® ❑ FCleanout between building and tank? ------ -- - -- - - - - - --- ❑ ® ❑ t..t Tank baffles present? -- - --_ _ _ _ _ _ _- ❑ ❑ I. 24"access risers over each compartment?----- - - - --- - - - - . ®1.11 ❑ ❑ N Effluent filter installed?---- - -------- - - --- - --- --- - .- ® ❑ ❑ Septic tank capacity(working) /,ROO gal Manufacturer unk"W. �o D-box water level' -- - --- _ . . ❑ NIA 0 ves ❑ No 00 Manifold/D-box accessible from surface?- - - - - - -- ---- --- - - ® ❑ ❑ m— Check valves installed? - - - - m. ❑ ❑ 2 Transport Line Size I.L'//} Schedule/Class rt�A Bedrooms installed(check one) ® 2 ❑3 ❑4 ❑ 5 ❑6 ❑Commercial/Other >10ft.from foundation?- - - - -- -- -- -- -- - - - - - - - -- --. El NIA ® YES NO >100 ft. from wells?- - ---- - ------ - - - - -- - ---- - - - -- ❑ m ❑ W >100 ft.from surface water?---- - - - - - --- - - -- - - - - - -- . ❑ ® ❑ a >10 ft.from potable water lines?- --- - - -- --- - - - - ❑ ❑ >5ft. from property lines and easements?- - -- - - -- - - - -- - -- ❑ © ❑ >30 ft.from downgradient curtain/foundation drains' - - -- -- - - - - ® ❑ ❑ Drainfield level - -- _ ❑ ❑ ❑ Graveless chambers or ® Clean gravel used? (check one) Proper cover installed over drainfield?- - - - -- - - - -- - - -- - --- ❑ ❑ Pump tank setbacks consistent with septic tank? --- -- -- ----- - R NIA ❑ YES ❑ No ZPump lank rapacity(flood) gal Manufacturer H24"access riser(s)and accessible from surface?-- - - - - -- - - - -- ❑ ❑ ❑ ca it. Alarm or Control Panel Installed? ----- - - - - - -- --- - ---- - ❑ ❑ ❑ Control Panel equipped with Timer/ETM/Counter- - --- - - - - - - ❑ Cl ❑ 4 Pumpinstalled in '' El or ❑ On Block or ❑ Other r �' Pump Make/Model ❑ Floats or ❑Transducer G a Tank draw down in/min Pump capacity gpm Squirt Height ft" rFF Pump on time Pump off time Daily flow set at t pd 4' updand ea,sna Mason County OSS Installation Report pg. 2 Parcel u ABANDONMENTRECORD Were existing septic components abandoned as part of this project? - - - - - - - --- - -- -- ❑ Yes No If yes, please describe: Were all components pumped out and properly abandoned per WAC246-272A-0300? - - - - - - - ❑ YES ❑ NO RECORD DRAWING This Is a permanent re and and meet%accuree and Eescripaw enough he reaoo a in the need of maimenanea inani,iea antl Iowa tlwelopmenc Typical RemN Drawings wnGin: DralnfieN 8 manlldE otlenbtion 6leyoul.Sep4pJiwnp bnN bofion,NaM armx,reserve tlrain�Itl.exeGng antl progosetl EUIIEinga.lwallpn INwells,watei,es, w 11s.obaenabon pods,deanou6,and other mainienama acwu podia. Incomplete Rafted!CindoWs may create Odsioal delays In frol in nallaWn approval add related Damns. SP¢. q+(W-W Record Drawing Attached CERTIFICATION OF INSTALLATION INSTALLER DESIGNER/ENGINEER 1 certify that 1 installed the system in accordance with I certify that the system has been installed in accor- the septic design stamped'APPROVED"by Mason dance with the septic design stamped"APPROVED"by County Public Health and that any deviations shown Mason County Public Health and that any deviations here have been cleared/approved by both the designer shown here have been clearedrapproved by both and Mason County Public Health and meet all State myself and Mason County Public Health and meet all and Mason County Codes. State and Mason County Codes I further certify that all information contained on this 1 further certify that all information contained on this form and attached Record Drawing is accurate. form and attached Record Drawing is accurate. Signature of Installer Date Panted Name of Signee Jwe`- MASON COUNTY PUBLIC HEALTH ie The unders/gned approves this Installation Report and g.".9'c; fnlrs Record Drawing on behal of Mason County Public Health: q/® 2 Signature of Environmental Health Specialist Date (stamp, signature and date) THIS FORM MAY BE SCANNED AND AVAILABLE FOR PUBLIC VIEW ON THE MASON COUNTY WEB SITE updawaztamg Ur3 z 3 c '� owiohr'i� m sory 9 0/IT Rve t Aeeo IZ p „Fled a A57 1$ 21' - - 5 a , WARR N zR,4 N Qf ztiv rN"e 5E67FoN r5,T2tNR) W �� �,URRENSRfGAup ' M- t'y3 of3 Iq E TRE4AAiD tT. tuam.i u/./ P~el